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General NPI Number Information
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NPI Number | 1235517061
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Entity Type | Individual
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Provider Name | GAIANA ISAKOV D.D.S
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Gender | Female
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 01/29/2020
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Provider Practice Location Address
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Address Line | 590 NICOLLS RD
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City | DEER PARK
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State | NY
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Zip | 11729-3217
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Country | US
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Telephone | 631-477-6777
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Fax | 631-477-6477
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Provider Business Mailing Address
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Address Line | 7 MAJESTIC DR
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City | DIX HILLS
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State | NY
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Zip | 11746-4857
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Country | US
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Telephone | 347-879-2967
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 058690
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License Number State | NY
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